Periodontal Disease and Its Bi-Directional Relationship with Systemic Disease: A Survey among Medical Interns and Graduates.

Janardhana Amaranath‘, Swati Mishra2, Rohit Gupta*, Rahul Srivastav*, Pallak Arora’, Shubhra

Kanodia®, Anubala Sharma’, Vishal P. Giri®

1Professor, Dept of Periodontology, Rama Dental College Hospital & Research Centre, Kanpur, U.P, India.

Post Graduate Student, Dept of Periodontology, Rama Dental College Hospital & Research Centre, Kanpur, U.P, India.

3Reader, Dept of Periodontology, Rama Dental College Hospital & Research Centre, Kanpur, U.P, India.

4Reader, Department of Oral Medicine & Radiology, Rama Dental College Hospital & Research Centre, Kanpur, U.P, India. >Reader, Department of Oral Medicine & Radiology, DJ College of Dental Sciences & Research, Modinagar, U.P, India.

®Senior Resident, Department of Dentistry, SRMSIMS, Bareilly, U.P, India.

“Junior Resident, Department of Dentistry, SRMSIMS, Bareilly, U.P, India.

8Assistant Professor, Department of Pharmacology, SRMSIMS, U.P, India.

Received: September 2017 Accepted: September 2017

Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: To assess the level of awareness on periodontal disease and its bidirectional relationship with systemic diseases among medical interns and graduates. Methods: A Cross sectional survey was conducted among 105 Medical interns and 53 Graduates in a medical college of northern India. Statistical analysis: Descriptive statistical analysis and chi-square test were used. Results: Regarding awareness on the importance of oral health 92% of the participants reported very important and 77.1% of them were aware of periodontal disease but only 6.7% of them were

knowing about the bidirectional relationship between periodontal disease and systemic diseases. 94.3% of the participants were agreed for the inclusion of certain dental topics on oral examination and diagnosis in medical curriculum. Conclusion: We conclude that there is an urgent need to include selected dental topics of oral examination and diagnosis in medical curriculum.

Keywords: Knowledge; Medical curriculum; Periodontal disease; Systemic disease

INTRODUCTION

their toxins such as cytolytic enzymes & lipopolysaccharides have access to the blood stream, a number of inflammatory mediators, including tumor necrosis factor alpha, interleukin

Periodontitis is an infectious disease associated with a small number of predominantly gram— negative microorganisms that exist in a subgingival

biofilm.!"! According to World Health Organization OE ene Ee eeton ate (WHO) 10 — 15% of the world populations suffer produced. These inflammatory mediators stimulate

from severe Periodontitis. In India it is the most a chronic inflammatory response in the body that

- on oral infection with a prevalence rate of lead to breakdown of connective tissue attachment

55.4% at the age of 12 and 89.2% in the age group leading to formation of periodontal pocket, alveolar

of 35-44 years and 79.4% in 65-74 years of age bone pasa gingival recession, tooth mobility & tooth loss.'°-*!

Although pathogenic bacteria are necessary for periodontal disease, they are not sufficient alone to cause the disease, a susceptible host is also imperative. The importance of host susceptibility is clearly evident in the medical literature. Many of

group."

Periodontal disease has many stages, ranging from easily treatable gingivitis to irreversible severe Periodontitis. During pathogenesis of _ the periodontal disease, periodontal pathogens and

Name & Address of Corresponding Author the systemic conditions act as a modifier or a risk Dr. Shubhra Kanodia, factor for Periodontitis. Two way relationship of Senior Resident, _ periodontitis and systemic disease such as enema cardiovascular disease, stroke, diabetes mellitus, U.P, India. preterm labour, preeclampsia and _ respiratory

condition such as chronic obstructive periodontal

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disease (COPD) and pneumonia has_ been established.!!>!

A number of possible biological pathways link 1s present between periodontal infection and systemic disease i,e (a) oral — hematogenous spread of periodontal pathogens and direct effects to target organs (b) Transtracheal spread of periodontal pathogens and direct effects to target organs (c) Oral hematogenous spread of cytokines and antibodies with effects at distant organs.'?!

The interrelation between dentistry and medicine has been documented throughout history. In the past, where knowledge of health science was very poor and where people had to survive epidemics of infectious diseases, oral health was far from a priority and likely very precarious, creating terrible images of dirty and decayed teeth with bad breath. Reports from the ancient Egyptian Medicine suggested that health of the body could be improved after tooth extractions. ©!

In the year 1891 Walter Miller described the mouth as a “focus of infection” through which “microorganisms or their waste products obtain entrance to parts of the body adjacent to or remote from the mouth.” In 1900 William Hunter believed that teeth are liable to septic infection. Mattila and co-workers in 1989 reintroduced the association between oral infection and systemic disease.!’! This relationship between periodontal health or disease and systemic health or disease has given rise to a discipline in periodontology termed as “Periodontal Medicine” by Offenbacher in the year 1996."*! Hence the present study was undertaken to assess the awareness among medical interns and graduates about the periodontal disease and its bidirectional relationship between systemic diseases in a medical college of northern India.

MATERIALS AND METHODS

The present study was carried out in one of the private medical college of northern states of India. Consent for conducting the study was obtained from the concerned authority of the institution, after appraising them regarding the purpose and significance of the study. This cross sectional survey was conducted among medical interns and graduates to assess the awareness on periodontal disease and its bidirectional relationship with systemic disease.

The study consisted of total 163 participants which included 105 interns and 53 medical graduates. A verbal consent was obtained from all the participants. The data was collected using a self structured, pretested questionnaire.

The questionnaire included the demographic details and 15 questions with multiple choice answers. The questions were framed to assess the awareness among study group regarding the importance of oral health in having good systemic health, on the

with Systemic Disease

cause and consequences of periodontal disease regarding the bidirectional relationship between periodontal disease and systemic diseases, about the attitude related to referral of their patient to periodontist or dentist and finally on their opinion on the inclusion of certain dental topics related to oral examination and diagnosis in the medical curriculum. The study participants were instructed not to discuss any answer with any of the study participants. The purpose of the study and all the terms used in the study were explained to participants and were ensured maintaining total confidentiality.

Statistical Analysis The responses were complied, computed and

statistically analyzed by descriptive _ statistical analysis and chi-square test. The results were expressed in terms of percentage.

RESULTS

All the participants answered each question. 92% of participants reported very important and 8% of them considered as moderately important, regarding the importance of oral health to have good systemic health, which is found to be statistically significant [Figure 1].

77.1% of them were aware of what is periodontal disease, 13.3% and 9.5% of the subjects reported no and not sure respectively on the awareness of periodontal disease, 44.8% were reported yes regarding awareness on the cause of periodontal disease and 27.6% of them responded no for the same. Regarding the awareness. on _ the consequences of periodontal disease, only 10.5% of them answered yes, 74.3% & 15.2% of them reported no and not sure respectively [Figure 2].

Related to bidirectional relationship between periodontal disease and systemic diseases 69.5% of participants were aware of the fact that certain systemic diseases can lead to periodontal disease. 21% & 9.5% were reported no and not sure respectively. Only 6.7% of study subjects reported as yes 78.1% and 15.2% responded as no and not sure respectively on the awareness regarding can periodontal disease lead to certain systemic disease [Figure 3].

On the referral of their patient to periodontist or dentist, only 23% of them referred sometimes and 77% never referred their patient to periodontist or dentist [Figure 4].

94.3% of them totally agreed for the inclusion of topics on oral examination and diagnosis in medical curriculum, only 1% and 4.8% of them reported disagree and not sure respectively [Figure =F

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92%

@ Very important @ Moderately important

Figure 1: Awareness on importance of Oral Health on

Systemic Health.

Do you know what are the consequences of Periodontal Disease

15.2 743 10.5 27.6 27.6 44.8 9.5 Do you know whatis Periodontal Disease ? 13.3 77.1

10 20 30 40 50 60 70 80 930

Do you know microbial deposits on the teeth is the cause forPeriodontal Disease

®| Notsure BNo WM Yes

Figure 2: Awareness on Periodontal disease, cause &

consequences.

78.1 . 69.5 60 EA _ 21 20 15.2 _ 95 No

Yes Not sure ® Do you know certain Systemic Diseases can lead to Periodontal Disease

& Do you knowPeriodontal Diseases can lead tocertain Systemic Diseases

Figure 3: Awareness on Bidirectional relationship between Periodontal disease and systemic disease

@ Sometimes

@ Never

Figure 4: Attitude of Medical graduates in referring

their patients to Dentist/ Periodontist

No opinion a 48

Disagree | 1

Figure 5: Regarding the inclusion of topics on Oral examination and Diagnosis in Medical curriculum

with Systemic Disease DISCUSSION

The World Health Organization (WHO) defined health in its broader sense in its 1948 constitution as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. The present study was based on the fact that medical doctors form a main group as primary health care providers and their awareness on the impact of periodontal disease on the systemic health is of utmost important, because there is a substantial amount of literature available on the bidirectional relationship between periodontal disease and systemic diseases that means periodontal disease could be one of the risk factor for many systemic diseases and large number of systemic diseases were also considered as a risk factor for periodontal disease.!”!

In our study 92% of the study participants were reported that it is very important to have a good oral health to have a good systemic health. In a previous study about 94% of medical and 80% of ayurveda students were aware that bad oral hygiene can cause adverse effects on general health, our finding on the awareness of the periodontal disease in the study population was found to be 44%. In an another study 80% of the study group were aware of the fact that plaque is the cause for periodontal disease."!!!

Only 6.7% our study subjects were aware of the influence of periodontal disease on systemic diseases. In a similar study 11% of the participants were aware on the systemic effects of periodontal disease among medical interns.!>!

As periodontal disease is very prevalent in India, it is very important to diagnose periodontal disease at its early stage there by to prevent the associated morbidity and mortality. Medical Healthcare professionals can act as a good source of knowledge providers to general public. Physicians receiving oral health related training will be capable of providing not only emergency care but also able to provide comprehensive counselling related to the cause of dental problems, methods of prevention, treatment and_ general health related issues. |!?!

CONCLUSION

The medical graduates and interns were aware of the fact that oral health is very important to achieve a good systemic health. They were not completely aware of the bidirectional relationship between periodontal disease and systemic diseases and also not adequately trained regarding the oral examination and diagnosis of oral and periodontal diseases. Now the time has come to connect medical science and dental science further by including the necessary dental topics on oral examination, diagnosis and periodontal medicine in

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10.

11.

12.

13.

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medical curriculum in order to provide a comprehensive health care for the public.

Acknowledgments We would also like to thank all the participants of

our study.

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How to cite this article: Amaranath J, Mishra S, Gupta R, Srivastav R, Arora P, Kanodia S, Sharma A, Giri VP. Periodontal Disease and Its Bi-Directional Relationship with Systemic Disease: A Survey among Medical Interns

and Graduates. Ann. Int. Med. Den. Res. 2017; 3(6):DE38-DE41.

Source of Support: Nil, Conflict of Interest: None declared

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